Comparative Classification Performance of Anthropometric, Body Composition, and Cardiometabolic Indices for Identifying ALAD-Defined Metabolic Syndrome in Panamanian Adults

Background: Composite anthropometric and cardiometabolic indices have emerged as practical tools for identifying metabolic syndrome (MetS), but their comparative classification performance against ALAD-defined MetS has not been comprehensively evaluated in Panamanian adults. This study compared the classification performance of selected anthropometric, body composition, and cardiometabolic indices for identifying metabolic syndrome defined according to the Latin American Diabetes Association (Asociación Latinoamericana de Diabetes [ALAD]) criteria in non-diabetic Panamanian adults. Methods: This cross-sectional study included 262 adults without diabetes (110 men and 152 women). Clinical and laboratory measurements were used to calculate the body mass index (BMI), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic index of plasma (AIP), cardiometabolic index (CMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Classification performance was evaluated using receiver operating characteristic (ROC) curve analysis, optimal cut-off values, and DeLong’s test. Age-adjusted logistic regression assessed associations between each index and ALAD-defined MetS. Results: Composite indices integrating anthropometric and metabolic parameters showed high classification performance. CMI had the highest observed AUC in men (AUC = 0.933; 95% CI: 0.887–0.979), whereas LAP had the highest observed AUC in women (AUC = 0.854; 95% CI: 0.778–0.931). Conclusions: CMI and LAP showed high classification performance for identifying ALAD-defined MetS in Panamanian adults without diabetes, with the highest observed AUCs in men and women, respectively. These simple, inexpensive indices may have potential utility as screening tools for identifying ALAD-defined MetS in primary healthcare settings. The proposed cut-off values are exploratory and require external validation in independent Panamanian and Latin American populations before clinical implementation.